Provider Demographics
NPI:1124671342
Name:HARBST, MORGAN TAYLOR
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:TAYLOR
Last Name:HARBST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 N 2ND ST APT 110
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-4324
Mailing Address - Country:US
Mailing Address - Phone:608-518-2874
Mailing Address - Fax:
Practice Address - Street 1:580 N 2ND ST APT 110
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-4324
Practice Address - Country:US
Practice Address - Phone:608-518-2874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4045133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered